PWE-005 Gastrostomy use in the south west for motor neurone disease patients

• Published in: Gut Vol. 68; no. Suppl 2; p. A175
• Main Authors: Gulliver, James, Dinata, Abdul, Bendall, Oliver, Bebb, James, Lee, Tracy
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2019
• Subjects: Amyotrophic lateral sclerosis; Demography; Diagnosis; Hospitals; Malnutrition; Mortality; Motor neurone disease; Ostomy; Statistical analysis
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.336

IntroductionMalnutrition is a significant problem for patients with motor neurone disease (MND). NICE recommend gastrostomy insertion for nutritional support is discussed at an early stage before respiratory impairment and weight loss increase the risks beyond acceptable limits. The ProGAS study found no mortality difference between percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) tube placement, nor did it provide definitive guidance concerning timing and route of gastrostomy insertion. This study reviews the use of gastrostomy tubes in the South West between two large hospitals.MethodsDatabases of MND patients from the Royal Cornwall Hospitals NHS Trust (RCH) and the University Hospitals Plymouth NHS Trust (UHP), together serving a population of 2 million people, who had gastrostomies inserted from 2011 to 2018 were included. Data was assimilated to include demographics, type of gastrostomy used, months to insertion from diagnosis, sedation use and mortality. Results were analysed using Microsoft Excel and described in means (+/- standard deviation). Two-tailed t-tests assuming unequal variance were performed in order to establish if there was a statistically significant difference between the means. P values < 0.05 were regarded as significant.ResultsThe RCH cohort (n=19) demonstrated a female preponderance (58% v 42%) and mean age of 70 (+/- 9 years). 42% received PEG, 47% RIG and 11% surgical gastrostomies. The mean insertion time from diagnosis was 10 months (+/- 11 months), with 30 day mortality 0%. Overall mortality was 58% in the study period with mean survival from diagnosis 28 months (+/- 29 months). The UHP cohort (n=54) were 54% male, 46% female, with a mean age of 67 years (+/- 12 years). 85% received PEG and 15% RIG. The mean insertion time from diagnosis was 11 months (+/- 14 months), with 30 day mortality 1.9%. Overall mortality was 87% with mean survival from diagnosis 23 months (+/- 16 months).The majority of PEG insertions were arranged on dedicated lists with anaesthetic cover (83% vs 17%) compared with only a minority of RIG insertions (18% vs 82%). There was no significant difference between time to insertion (P = 0.78) and survival from diagnosis (P = 0.61) between the 2 cohorts.ConclusionsGastrostomy use in the South West is safe, with mortality rates below quoted literature. Gastrostomy practice differs between the 2 hospitals in the approach used but time to insertion and mean survival was not different. The authors intend to pursue a joint referral pathway for gastrostomy assessment. This would improve data collection quality, allowing future analysis of standardised variables to ascertain the most effective use of gastrostomies in these patients.